Colorectal Cancer Screening Should Begin at Age 45

Arthur Winer, MD, is a specialty care physician at Inova Schar Cancer Institute. Dr. Winer is board-certified in internal medicine, hematology and medical oncology. He is a practicing gastrointestinal medical oncologist and has clinical interests in colorectal, esophageal, gastrointestinal, liver and pancreatic cancers.

For decades, experts advised people to begin colorectal cancer screening at age 50. But recently, the U.S. Preventive Services Task Force (USPSTF) revised these long-standing recommendations. This group of medical experts concluded that screening for colorectal cancer should start earlier — at age 45.

This new recommendation is a major change for cancer screening guidelines. And it’s in direct response to the rising rates of colorectal cancer among younger people.

What Is Colorectal Cancer?

Colorectal cancer is cancer that begins in the colon or rectum, which are parts of the large intestine. This cancer typically happens when benign growths, called polyps, form inside the colon or rectum. Over time, some of these polyps change into cancer.

Colorectal cancer is the third most common cancer in women and men. And it’s the second leading cause of cancer-related death in men and women combined.

Screening can prevent many of these deaths. That’s because screening tests can find polyps early, before they turn into cancer. Screening tests can also find early-stage colorectal cancer, when it’s easier to treat and outcomes are better.

Why Did the USPSTF Lower the Colorectal Screening Age?

Most colorectal cancer cases occur in older adults; in fact, 50 percent of cases occur in people over the age of 67. That’s why, for years, experts recommended people begin screening at age 50.

But since the 1990s, the rate of colorectal cancer has more than doubled in adults under age 50. Nearly 18,000 people under the age of 50 will receive a colorectal cancer diagnosis this year. And more younger people are dying of the disease, too.

The science shows that colorectal screening saves lives. And because colorectal cancer is affecting people in their 40s or younger, screening needs to start at an earlier age.

Average Risk Versus High Risk of Colorectal Cancer

This new recommendation applies to people at average risk of colorectal cancer. But you may need to start colorectal cancer screening at a younger age if you have certain risk factors, including:

• Inflammatory bowel disease (IBD): Crohn’s disease or ulcerative colitis are types of IBD. They cause chronic inflammation of the gastrointestinal tract.
• Personal history of colorectal cancer: If you’ve already had colorectal cancer, you have a higher risk of getting it again.
• Family history of colorectal cancer: If you have an immediate family member who had colorectal cancer, your risk of getting this cancer is higher.
• Personal or family history of colorectal polyps: If you or someone in your immediate family had colorectal polyps, you have a higher risk of colorectal cancer.
• Certain genetic syndromes: Familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer (Lynch syndrome) cause multiple polyps at a young age. These syndromes and a few others can lead to colorectal cancer.

However, most people who get colorectal cancer have no family history of the disease or a clear underlying predisposition. That’s why it’s important to start screening at age 45, even if you have no risk factors.

Colorectal Cancer Screening Options

There are several choices for colorectal cancer screening. Talk with your doctor about your options and which test is right for you.

Colorectal Cancer Stool Tests

Stool tests are usually done at home with a kit you get from your doctor. You put a sample of stool in a provided container and return the sample to your doctor or a lab. Your doctor will provide you with instructions on how to get the sample and where to return it.

Colorectal cancer stool tests include:

• Guaiac-based fecal occult blood test (gFOBT): This test uses the chemical guaiac to look for blood in the stool. You should get this test once a year.
• Fecal immunochemical test (FIT): This test uses antibodies to look for blood in the stool. You should get this test once a year.
• FIT-DNA test: This test combines the FIT with a test that looks for cancer cells in the stool. You should get this test once every three years.

Colorectal Cancer Imaging

With an imaging test, doctors look inside the colon and rectum with thin, specialized instruments. Doctors can remove any polyps they find during some of these tests, avoiding the need for a separate procedure.

Some people shy away from imaging tests because they think they will cause pain. However, in the U.S., doctors use sedation to make patients comfortable and relaxed. Most people find that these tests cause no discomfort and don’t remember the procedure.

The preparation for colorectal cancer imaging tests involves taking laxatives to empty the bowels. Many people find the prep tolerable if they have easy access to a bathroom and know what to expect. Remember, a few hours of diarrhea is well worth the potentially life-saving benefits of early cancer detection.

If you’re concerned about the prep, talk with your doctor about it. Often, doctors can make modifications to the prep to make it as easy as possible for you.

Imaging tests include:

• Colonoscopy: During this test, the doctor guides a thin, flexible, lighted tube into the rectum. The doctor examines the entire rectum and colon for polyps or signs of cancer. If you have an average risk, you will usually have a colonoscopy once every 10 years. You may also need a follow-up colonoscopy if you had an abnormal result from a stool test.
• Flexible sigmoidoscopy: This test is like a colonoscopy, but it only examines the lower third of the colon. People who have an average risk may get this test done once every five years. You may also be able to do this test every 10 years when it’s combined with a yearly FIT stool test.
• CT colonography or virtual colonoscopy: This test uses X-rays and specialized computers to produce images of the colon. People who have an average risk may get this test once every five years.

Get Started with Colorectal Cancer Screening

To find out more about colorectal cancer screening, schedule an appointment with your Inova Gastroenterologist using your MyChart patient portal. If you do not have a Gastroenterologist, we welcome you contact us  to make an appointment with a provider at any of our GI locations.